1986, 12-23 Permit App: 87000037 FurnacecO
MECHANICAL PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not.presume to give authority to
violate or cancel the provisions of any state of local laws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
/� DATECATION /A .3 G/Gi
Project It -Rfs"��C.lJg7
O �
Owner's Name Last First MI
4)/1n(/7a Al tilA/)/ I.1
Project Addr (Street Name & Number _
/5dl ? .0 mg �
City
Sljd 4—Li Z—
State
(1 ..
Subdwis n/ Plat Name
-Wm/ 2
Assessors Parcel M /554j2.— (I 61
Lot /
Block'
Plat N
Applicant
Address
City
State
Zip
Phone
Business Phone
Contractor
N» 4do ("4"—)4 7/1//1 it- /C°
Add
Te'r 4;7'
City
9,d A ,r2 b=
State
br) 4
Zip
99a /Q
Phone
-, 3 `Y--/y7s .
ContactLicense
A ' 1c'
tt
,2,22W S''eia14- /71 /22..
Business Phone
39C/i-,--:75---- 5 '/ -v7 r
.P
Describe Work eels//8I
Fans
Evaporative Cooler
Hoods
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Wate Htr.
Solid Fuel/ Wood Stove
Air Handling Units
0-10,000 CFM
10,000+ CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over1750M
Compressor
0-3HP
3-15HP
15-30HP
30-50HP
50+HP
Gas Piping
1-5 Outlets
6+ Outlets
Gas Fired Heating System
--
1-10000,,0000BB'TU�/ �
106,C.00 + BTU
--nn '''' s� Qt. ,, �//j am ---/ !")7-7/
'
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not.presume to give authority to
violate or cancel the provisions of any state of local laws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR
/� DATECATION /A .3 G/Gi